We woke up in the morning, had coffee, and then headed to what is called the Blue House. And then there were some bureaucratic procedures. As we were waiting for the nurse, Moshe wanted to record a few things. He wanted his family to know that the end was peaceful, intentional, and with acceptance and love. So, we recorded some videos for them about this. He was crying a little bit; it was just very emotional. It was not sadness. It was love and gratitude. I think even happiness that things were about to be over.

And then the procedure started. He had an IV and there’s this machine that pushes a syringe with the medication. They first put IV fluid—saline water—in it. And he pressed the button to see what he should do and how things get pressed and so on. When he saw all of this, they replaced the saline syringe with the medication. They asked him if he was ready. I gave him one last hug. I told him I loved him. He said he loved me back. He said thank you for the last few days, that he couldn’t have imagined them being better. And then, with conviction, I sat back. I told him that he should know how loved he is. He said he both knows it and he feels it. And then he leaned forward and with a lot of positive conviction— his hand not shaking—he pressed the button, leaned back into his chair, and in a few seconds he was asleep. You could see the peacefulness setting in. Within, I don’t know, 20-30 seconds, he stopped breathing.

We sat there for a while—the staff left and I sat there for a while. And then it was so strange. I got up and got a taxi and went to the airport. It was only when I arrived at the airport that I started feeling physically strange. I had time before my flight, so I tried to write and I realized how much pain I had in my hands. I always have a little bit of pain, but this was a lot more. I couldn’t even write. It became clear to me that it was not just physical pain. It was a combination of the emotional, mental, and the physical pain together that I was experiencing. Together it was just too much. Then I noticed that my whole body was shaking. Not big shakes, just little shakes. It felt that something was wrong physically. Flying there with him and then flying back alone with some of his possessions; there was something very tough about that. But on the flight, just as we were about to land, I went over the last four days, and I felt that I really did a good job. I made him happy and they were contemplative and thoughtful. He shared and I shared. And we talked a little bit about things like procedures and the letters that he wanted to write. But it was a time that was psychologically rich with experiences, with thoughts, with friendship, with caring. And I really feel that I stood up to my commitment on this in the best possible way. I was thinking that this may be my purpose in life. I think I did it very well.

He will be missed. I don’t know exactly how I’ll process the grieving and the experience and so on. But what a guy. He left me with lots of thoughts.

Maybe the most salient now is that it is possible to go peacefully if you feel that you’ve achieved the main missions in your life. Not just peacefully, but with the acceptance and even happiness to end life if you feel that you’ve been successful and that happiness and sadness can live side by side about the end of life.

I’ll keep contemplating this.

It’s Thursday night. Tomorrow is Friday. Tomorrow is the day of the medication.

We’ve had a few very intense days for both of us. We spent many hours every day talking about lots of topics, got very close, and shared lots of things. In addition to sharing, I was also trying to figure out what is my role in this. How do I stay helpful? I don’t even know how to summarize all the all the things that happened.

Maybe I would say a couple of things that had the most impact on me. One, is the peacefulness of knowing the end that comes with it. It is surprising from an outside perspective to see that calmness about tomorrow—100% conviction, no question, and calmness. The second thing is the ability to enjoy things. Going for coffee, for ice cream, looking at the scenery. We talked all through the day and went for a few walks every day. We had coffee and drinks and ice cream and some food. The ability to appreciate the weather and the fountains and the streets, the taste of the coffee and the ice cream and being inquisitive. The conviction I thought would waver to some degree—I didn’t think it would go to no, but I thought the ability to extract a lot of joy from these days for both of us. And it’s a duality. It’s not joy and no sadness. It’s both things side by side. The third thing which we had lots of discussions about today, was about the fact that he feels that he has done his job in many areas of his life. He feels he’s been successful professionally as a very, very successful therapist has helped lots of people. He showed me some comments from patients. As a significant other—it’s amazing to listen to the love that they were able to develop. And as a father with three amazing kids with amazing relationships. You would say that somebody who has checked the boxes who is happy professionally and happy romantically and feel that they’ve done their job—you would wonder wouldn’t they want to just push on for another few days? Few weeks? Few months?

The answer was that’s one of the things that gave him the power to let go. What he said was that he does not have any unresolved issues. He figures that he’s done his best in each of those. He’s achieved what he wanted to achieve, and now it’s easier to let go. He said, is it sadder to give on a successful, happy life than to give on an unsuccessful, unhappy life? Yes, it is sadder. But does it help with the acceptance? Absolutely. And his level of acceptance is very high.

We just got back to the hotel. I did not sleep much the last two days. I don’t know what will happen tonight. We will see. But what a privilege. I feel that I got to meet someone for multiple days in a very intense environment, learn a lot about them, for them, for him to learn a lot about me. Shared lots of thoughts and ideas and gave me lessons for life, and some criticism, and suggestions.

It will be a lot of material that I will keep on digesting and thinking about.

That’s it for now.

And I thought that most of us don’t witness dying that much anymore. Think to yourself, how many people have you witnessed at the end of their life? A long time ago, when we lived in small communities with larger families, people would gather at the house of those who are terminally sick. They would bring food and help and be there at the moment of sickness and participate and know what was going on. Maybe that also created a lower level of fear. And now we have movies, but most of us have not experienced being at the bedside of somebody who’s taking their last breath. The experience Moshe described of witnessing the end of the life of his dogs is not very common. Maybe more for dog lovers than not. But maybe we need something like this. Maybe we need to witness the end of life to change how afraid we are of this.

We will see. I will tell you on the other end of this about my own fears. Actually, I can tell you already because I was there with my mother when she passed away. I wasn’t that afraid before, but it was very comforting to see that my mother did not suffer. That she basically went to sleep and overnight her sleeping got deeper and her breathing slowed to fewer breaths per minute. It became slower and then it just stopped. There weren’t any signs of stress or pain. It was comforting.

I’m sure this will be painful (for me). My mother’s end of life was painful and sad and I cried a lot. But it was also comforting to know that it’s not a gasping for breath and the feeling like you’re drowning.

He said if he only listened to the social pressures, it could go on for a very, very long time. It’s not clear when the social pressure would end. The only thing that is clear is that it’s not good right now. He said if things kept being just like this would I want them to continue, he said no. So why delay? Why not end things? The same thing went for saying goodbye. He said he could continue corresponding with his family members, he could continue telling them he loves them. But they had a very good ending and meeting and summary why procrastinate more? Why delay things more?

I think, in general, procrastination is a huge problem for human nature. It’s a cause for lots of the things we don’t do well. But maybe the end of life is one of the cases where procrastination is the worst for us—much worse than procrastinating on paperwork and filing our taxes and so on—that we don’t want to get to that moment. And because we don’t want to get to that moment, we’re doing lots of things that are not good for anybody.

He said that if he asked his family if today is the right day, they would have said no. And then tomorrow, they again would have said no. There’s a story of when is it worthwhile to stop smoking. And the answer is that if you think long term, you say smoking is terrible. But if you think about it one day at a time, it will never be a good day to quit smoking. Why? Because if you’re a smoker and you love smoking, every day you smoke is a good day. And every day you smoke is not going to kill you—not that day alone. So, if you wake up every day and ask if today is a good day to stop smoking? Every day you would say, not today, not today, not today. But if you say, do I want to keep on being a smoker? You would say, no, I don’t.

And I think the same thing is true here. If we think short term, every day we would say, not today, not today, not today. But if you say, do I want to live like this, in general? The answer is no. And if the answer is no, then you know what you should do sooner.

So very courageous. Picking a date. Sticking to it. Saying goodbye in the right way. Procrastination and end of life.

I think that in many ways his end was when he left home. The end is not the day after tomorrow. It’s not these few days here with me. The end, in the most important way, was when he said goodbye to his family and closed the door behind him and went to the airport.

But that’s outside of my control. But part of what is in my control is these few days. We have these four days together, and then of course the actual end.

We just came back from breakfast. We’re going to go for a walk by the lake. We’re having deep, meaningful conversation. I would say that I have a good sense that these days can be good and powerful and meaningful. I think they have been so far. We’re not talking about anything trivial, just about life wisdom and lessons and sharing—good and bad—some of his history. Kind of like a mutual confession, I would say. I think it’s cleansing. I think it’s good. It’s not easy. I think I’m in service. So, I keep thinking about how I can make this useful and valuable and rewarding in some way. Not pleasant; it’s not about pleasant, but it’s about some sense of satisfaction and joy. I keep thinking about his perspective and doing my best to give him what I think he wants. I would say that it’s taxing, it’s intensive, and it’s rewarding. But I think it’s very positive as well.

I’ll come back to report more as I learn more and I have more thoughts. But for now if the question is: Can the ending be good? I think the answer is yes.

One more thought. There’s this research on how important the ending is. That the ending really colors everything else that came before it. We end the meal with dessert and it colors everything before. And I think in that regard, a good ending is an ending that colors everything in a positive way. And I think that’s what I’m trying to think about and figure out how to do well.

Okay, it’s a good ending.

One more video having to do with end of life and the person that I’m traveling with to Dignitas in Switzerland. The story of that individual is that almost two years ago he decided that it was time to end things. He applied to Dignitas and was accepted. There was no date set, but there was the decision. He decided that’s how he wanted his life to end.

He applied to Dignitas to make sure this would be possible and then gathered his family to tell them about his decision even though there was not a date. There was just the general decision. As he finished, one of his kids said that they also had an announcement and pulled out an ultrasound of their eight-week pregnancy.

My person, of course, was very happy about this news and delayed things. It turns out that there were many delays for the next (almost) two years. All sorts of things that had a date that the family implied, that he wanted to wait for. And he kept delaying and delaying and delaying until he recently decided to not delay anymore.

There continue to be many reasons that he can delay for, but he has decided against any more. I asked him how he feels about the last year and a half when he extended his life and got to experience all kinds of wonderful things. He said he is positive about that part—that he got to do lots of things. But if his family would have been okay with it, he would have stopped a while ago. He said that he was happy he was there for them, for the celebrations and, not to sadden them before an event. But he said for him, it would have been better to part a while ago.

I asked him if, of the delays he had, how many were purely for him and how many were because he felt that his family wanted it—as a father, potential grandfather, husband—and he wanted to fulfill his duties? What was the percentage?

He said about 80% of the effect were that he wanted to do it for them. He wanted to do it—not directly for him. But because it was important for them.

It reminded me that in some of the research we did on end of life, we found that often the patient is in much higher acceptance. They accepted their fate and are not as anxious about it. And the family, of course, is in a different place.

I don’t know whether this delay was overall good or not. It’s hard to judge—retrospective judgment and so on. But I think the insight that people make lots of decisions including at the end of life, because of others, is certainly important for good and for bad. What do we ask people to do for us? I asked him for his perspective how much he did for himself vs. for them. I did not talk to his family and I don’t think I will. But how do they feel about asking him to continue something that is good for them but maybe not good for him?

This whole topic has lots of complexities. Hopefully over time there will be some answers.

I was thinking about the time that we will have together. The process takes a few days. You arrive one day, there’s a meeting with a psychologist and a clinician another day, another meeting with a psychologist and clinician to make sure that the person really wants to go through with this. And we’re going to have a lot of quality time together. And then there’s going to be the actual procedure.

But the procedure will be relatively short, and we’ll have quite a few days together.

The procedure, I’m sure, will be sad. I’ll do what I can to be there for him in the way that he wants me to. I am wondering what the multiple days will be like. He will be thinking about the clock counting backwards. I will be thinking about the clock counting backwards. What is possible under those conditions? He wants to learn new things, to think new thoughts, to get to know each other better, to share. He doesn’t want to be sad. He wants to be optimistic and think about life.

What will these conversations be like? Will I be able to set aside that countdown and focus on the moment? Will having the countdown make the moments feel more precious? How will it change from day to day? Maybe three days before will feel like a long time. Maybe the night before will feel different. I don’t know.

I am positive that I can be there for him. And I think I’ll do a good job with whatever he wants. I think he picked me for a particular reason that was good for him. I don’t know what other people would want, but I think he most likely can get what he wants from me. I will be there for him in the best possible way. But what will it be like for me? I don’t know.

He also said that he didn’t want his family to fly one way there with him and then back without him. He said that it will be less traumatic for me to do it. That’s also true. I’m sure it will be traumatic to some degree. I don’t know to what. Certainly, less for me than his family. So, he’s asking me to accept the burden and not his family.

But how will it be? How will it be to be there? How will it be over time? How will the procedure be? How will flying back alone be? I’m hoping that I cand do what he wants me to. That’s the main thing. I need to figure out how to do that in the best possible way.

The discussions about end of life are sad. But I think they also help us think about the positive things about life.

So, I used to think of quality of life as the main factor for deciding whether to continue or not. As you know, I’m helping somebody who’s going to end their life at Dignitas and I’ve been trying to help him think about when the right time is to make this decision. Imagine that you have options between a very miserable life, very good life, or neutral. Where are you in that? If you are on the positive side, that’s great. If it’s both positive and negative, it’s complex. If it’s just negative, it’s easier.

I thought that what people should do is take the pluses and the negatives and if you’re in the plus side all day then you’d choose to stay alive. If you’re in the negative side all day, then it’s time to end things. If you’re in both the plus and negative sides, it’s a complex computation of what to do (one day I might go into my thoughts about this). This particular guy’s quality of life is mixed but leaning more positive. So, it’s not positive all the time and it’s also not negative all the time. When I thought about the mix, I thought that it was pointing to staying alive for a bit longer until the mix gets worse.

But in discussions with him, I got the feeling that he thinks his current state of functioning is a disgrace to his own history. He said that if he had a different history then maybe the way he is now, would have been acceptable for somebody in terms of pure quality of life for a bit longer. Not for much longer but for a bit longer. He said his autonomy, his freedom, the ability to do things, the pride he had in himself and in his body, his ability to do his job, and the pride he took in providing for his family were a lot of the things that built his life. He said that the chapter he is in now is positive if you look at it by itself, but it’s a disgrace—he used this word—to his old self. He said that enters his computation. It’s not just about the moment; it’s about the fact that he feels that staying alive now is taking away from who he was.

I don’t know how to settle this thought. It’s still complex and I’m still thinking about it. But it means that when elements that build somebody’s identity (autonomy, pride, providing, a job that he loves, etc.) are taken away, it creates a negative feeling even though it’s relative. If he didn’t have the comparison this would have been fine, but he cannot help but think of it relative to the past.

And that feeling of betraying his old self—betraying what he always thought, believed, wanted to do—adds another component of making life unbearable. It’s a very complex thought. It’s very hard for me to put myself in his shoes and try to get a sense of whether I would feel the same or not. I don’t know. I do know that he has a lot of conviction around that thought.

I thought I’d share it with you and if I ever learn more about this, I will return to it.

Thoughts about death are very sad. But I hope you don’t find it only sad. It also helps us think life. About the positive things.

As you know by now, I became an end-of-life doula and I’m going with somebody to Dignitas in Switzerland. He decided that he wants me to go with him instead of his family. We had lots of discussions about this decision. Before I share his reasoning, think about what you would do and what you would want.

Now for what he told me. He said that during his last few days (the process requires about three days partially filled with meetings, verifications, and so on) he wants to focus on positive things. He said he wants to learn something new. He knows me a little bit, but he wants to get to know me better. He wants to talk about philosophy and ideals about life. He said he doesn’t want to be sad. He doesn’t want to look at pictures of himself in his youth. He doesn’t want to see the kids and the grandchildren he will leave behind. He said he wants to depart from his family, and he doesn’t want to feel that maybe he made a bad decision during these three days. He doesn’t want to feel guilt. He mostly doesn’t want to feel sad. He wants to try to be in a good place emotionally. He said that if he is with his family he’s worried that he will see them crying, that he will start crying, that it will be sad and difficult. He doesn’t want that.

Now, I will say that when my mother was passing away, she also did not want to look at pictures. There was a point in her illness where she did not want the sadness. I also felt very strongly that that at the end she didn’t want to see us crying and we tried very hard not to cry.

So, you know, when he initially asked me to join him, I thought that there were maybe friction in the family or maybe there were some things that were not going well and that’s why he asked me. But then he explained his reasoning and I have to say that I understand his perspective. It’s complex, it’s painful. But I do understand it.

I’m thinking about what I would want and I think I would want the same thing. I think going into this difficult process with a very fixed time, I don’t think I would want to see the sadness in anybody’s face. I think I really would want both—to be with the people I love but without sadness. But I don’t think that’s possible.

So maybe he is correct.

Very sad and I hope you also find it very interesting.

The continuation of discussions about end of life. As you know, I became an end-of-life doula and I’m going with somebody for the first time to Switzerland to end their life at Dignitas. A place where you can do it legally and safely and at the right time.

I was thinking about timing. So, we got the documents from Dignitas, and there’s meeting one meeting with a physician and meeting two with a psychologist, and then there’s the meeting for the medication.

It’s at 10 a.m. on a particular date.

When I think of the people who I helped toward the end of their lives or the people from my family that I got to see—nobody had a date and an hour that was this precise. Think about it. When is it that we have a date so precisely?

You might be summoned to a court date. Or maybe there’s a discussion with your boss and you think that maybe they’ll ask you to leave. There are a few things that we have dates in advance, that are very, very precise. But even the dates that are very precise, maybe the meeting with your boss you think will not go well but you’re not 100% sure. You have a court trial, you’re not really sure how it will turn out.

This one is so precise. And I think it’s a unique perspective.

I have to say that this question has probably crossed all our minds. Would you like to know when you’re going to die? I think I would like to have like a general sense. Is it five years or ten years or twenty years from now? Would I like to know the exact date well in advance? I don’t think so. If I knew in ten years on April 13^th that I’ll die? I don’t think I would want that. But in the short term, the person I’m escorting, he’s finding that date incredibly positive.

He knows there’ll be a date when he stops suffering. He has a list of things he wants to accomplish between now and then. He’s meeting with lots of people. He said he’s not explaining his choice to anybody. We can talk about other things, but he’s not interested in explaining his choice over and over.

Maybe for me—and I wonder what it is for you—I would like to have a general sense and only when I get very close, I think I would like to have a specific sense, like the exact time to prepare, to settle things.

You know, when I thought about getting that letter, I thought it would be frightening for him. I thought the date would be, even though he wanted it, I thought that every day that would pass would be that hour and that date would be difficult, but no, it’s just positive.

I don’t know if I’ll ever be in his shoes and able to make such decisions. I’m very curious. The good thing about all of this is that he is positive. Very positive. And much more positive than I was expecting with that.

Some things to think about.

This person decided to end their life in Switzerland at a place called Dignitas. It’s a place that you can legally go and physicians are allowed to end someone’s life. There are lots of terms, forms, conditions, somebody has to be terminally ill, etc. A little while ago, this person I’m helping received the date on which they would give him the medication. I asked him how it was to get the letter with the date—there’s something very concrete about that—and how his well-being has been before and after receiving the date. He told me two things: one I think is interesting and one is fascinating.

The first one, interesting, he said how much relief there was to get the letter. He wasn’t dreading it. He was waiting for it. The moment he got it, he was hoping for it. He filled out all the paperwork and so on. And he said how much relief was in that. I think that’s interesting.

What’s the fascinating part? The fascinating part is when I asked him about his quality of life. How was his day to day since? And he said it has been dramatically better than before. He said that before, he was paying a lot of attention to his body parts that were not working. Getting up off of a chair, the pain here, the pain there—difficulty in all kinds of things. He’s had cancer for a while and there are lots of systems that don’t work as well. He said that before he got the letter and before he had a date, most of his attention was directed at the things that were not working. If he was trying to get out of a chair, for example, the things that were not working took his attention.

He said that after he got the letter, he stopped paying attention to the negative things and started paying attention only to the positive things. He said the signals of the illness (things that were getting worse, things were not working well), he knows will be taken care of in three weeks and he can focus on the positive things. He said it was a shift in attention.

It reminded me of research by Lara Carstensen, who showed that young people focus on the negative and the positive, but often more on the negative. As people get older, we start focusing less on the negative and more on the positive. This is why young people think they must be really miserable. They’re not. They’re focusing more on the positive. She attributed it to the idea that there’s lots to learn from negative things. And when you’re young, you should focus on the negative things. But as you get older, there are still a lot of things to learn from negative things, you just have less time to use it, so why not focus on the positive things?

In my friend’s situation, it is an extreme. Negative things in life give us information, signals, what to avoid, and what to worry about. But the moment he knows the date that thing becomes less important, and suddenly he has room to only think of the positive. He said he’s expecting a fantastic three weeks ahead, focusing only on the positive things.

I hope you find this both sad, as I do, but also important and fascinating. I’m both heartbroken about him and also relieved for him that his suffering will end soon.

It’s a complex emotion.

Bye for now.